Provider Demographics
NPI:1548261167
Name:DISCOUNT MEDICAL SUPPLY
Entity type:Organization
Organization Name:DISCOUNT MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:KUSHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-954-9066
Mailing Address - Street 1:2045 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-2701
Mailing Address - Country:US
Mailing Address - Phone:941-954-9066
Mailing Address - Fax:941-953-2960
Practice Address - Street 1:2045 12TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-2701
Practice Address - Country:US
Practice Address - Phone:941-954-9066
Practice Address - Fax:941-953-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6880123144618332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0130120001OtherMCR
FL0275560004OtherMEDICARE
FL0275560003OtherMEDICARE
FL950485100Medicaid
FL0130120001OtherMCR